Family medicine (FM) and emergency medicine (EM) have Accreditation Council for Graduate Medical Education-mandated point-of-care ultrasound (POCUS) training. While POCUS has many uses in internal medicine (IM), lack of mandated training has resulted in wide variation and lack of standardization in graduate medical education (GME) curricula. To perform a narrative review asking the questions: what are the recommended POCUS curriculum elements across FM, EM, and IM, and how can these inform the development of a more standardized curriculum? This narrative review was conducted in March 2024. Authors searched published materials from the following organizations: Canadian Association of Emergency Physicians, American College of Emergency Physicians, College of Family Physicians of Canada, American Academy of Family Physicians, Canadian Society of Internal Medicine, Society of Hospital Medicine, Society of General Internal Medicine, Alliance for Academic Internal Medicine, and American College of Physicians. Only documents endorsed for POCUS training/education were included. Narrative review was chosen due to the small number and large heterogeneity of documents. All documents were reviewed, and common themes were identified by the authors of the study; they were later compared using a large language model, and authors verified by repeat analysis. Nine documents, 2 online courses, and 5 procedural position statements were identified and reviewed. Both authors agreed on the final themes: POCUS uses, basic knowledge and teaching methods for POCUS, image number requirements and competency assessment, and quality control. There is overlap between recommended curricula for POCUS in major organizations. Internal medicine does not have an apparent defined, standardized curriculum for GME.

Mechanical chest compression devices and transesophageal echocardiography have become increasingly popular in cardiac arrest management. However, combining these technologies in live patient research is limited due to the rarity of cardiac arrest cases and the specialised nature of both tools. Cadaver models present a potential alternative for study. To evaluate the feasibility of using cadavers to assess transesophageal echocardiography image quality during LUCAS (Lund University Cardiopulmonary Assist System)-assisted compressions and to determine whether these models allow identification of the area of maximal compression. We conducted a prospective feasibility study using two unembalmed, previously frozen, and exsanguinated cadavers. Standard transesophageal echocardiography views, including the Mid-Esophageal Long-Axis and Mid-Esophageal Four Chamber, were attempted. The primary outcome was assessing image quality with the ACEP (American College of Emergency Physicians) Emergency Ultrasound Reporting Guidelines; the secondary outcome was the ability to identify and measure the area of maximal compression. Inter-rater reliability was calculated using Cohen's Kappa. A total of 12 transesophageal echocardiography videos were recorded. Mean image quality was rated as 1.8 and 2.1 out of 5, suggesting that structures were minimally recognisable but inadequate for diagnosis. Cohen's Kappa was 0.32, indicating fair inter-rater agreement. Due to poor image quality, the area of maximal compression could not be reliably identified or measured. Unembalmed cadavers are suboptimal models for evaluating transesophageal echocardiography during mechanical chest compressions. These findings, though negative, provide insight into the limitations of cadaveric simulations for transesophageal echocardiography-guided cardiopulmonary resuscitation research. Alternative models, such as high-fidelity manikins or better optimised cadavers, may be better suited for future investigations.

Since 2018, the Geriatric Emergency Department (GED) Accreditation Program has recognized Emergency Departments (EDs) that provide high-quality care tailored to older adults. GEDs have expanded rapidly across the United States in recent years, but little is known about how GED care is associated with patient outcomes, including hospital admissions and subsequent mortality. We used the 2018-2021 Health and Retirement Study (HRS)-Medicare linked data of adults aged ≥ 65 years. We supplemented these data with the American College of Emergency Physicians (ACEP) GED accreditation list and American Hospital Association (AHA) data. Receipt of acute care in a GED was defined as having an ED visit at a GED. Patient-level analyses were conducted using each individual's most recent ED visit. Multivariable logistic regression models were used to estimate associations between receipt of acute care in a GED and outcomes of hospital admission and 30-day mortality, adjusting for patient demographics, socioeconomic status, health conditions, ED visit severity, and hospital-level characteristics. Among 4563 older adults who had an ED visit, 270 (5.9%) received acute care in GEDs and 4293 (94.1%) received non-GED care. Compared with those treated in non-GEDs, patients treated in GEDs had significantly lower odds of hospital admission (OR, 0.61; 95% CI, 0.42-0.87; p < 0.01) and 30-day mortality (OR, 0.62; 95% CI, 0.40-0.96; p < 0.05). Subgroup analyses showed that the association with admission was more pronounced among adults aged 65-80 years (OR, 0.43; 95% CI, 0.24-0.76; p < 0.01) and non-Hispanic White individuals (OR, 0.51; 95% CI, 0.34-0.78). An association with lower mortality was observed among non-Hispanic White individuals (OR, 0.51; 95% CI, 0.30-0.87; p < 0.05). GED care was associated with lower odds of hospital admissions and 30-day mortality among older adults. Broader implementation may expand the reach of GED programs across diverse populations.

To evaluate the effectiveness of a theory-informed, iterative implementation strategy (IS) to improve point-of-care ultrasound (POCUS) documentation compliance among emergency medicine (EM) residents according to American College of Emergency Physicians (ACEP) guidelines in a high-volume emergency department (ED). We conducted a 19-month (December 2023-June 2025) mixed-methods implementation study at a tertiary academic ED in India. The Consolidated Framework for Implementation Research (CFIR) and Expert Recommendations for Implementing Change guided six iterative IS phases, including education, co-design, workflow optimisation and audit/feedback. Participants were EM residents. The primary outcome was the proportion of POCUS examinations achieving ≥80% compliance with ACEP documentation standards. Compliance trends were analysed across phases and summarised using proportions and medians with IQRs. Qualitative data from five focus group discussions were analysed using CFIR to identify barriers, facilitators and mechanisms of change. Quantitative and qualitative findings were integrated using a joint display. We assessed 3074 POCUS examinations. The proportion of scans achieving ≥80% compliance increased from 0% at baseline to 35.1% postimplementation. Median compliance rose from 24% (IQR 17-34) to 69% (IQR 54-84). Compliance followed a nonlinear trajectory. Initial phases showed minimal gains (0%-8.7%) due to workflow barriers. A marked acceleration occurred during IS-5 (22.5%) following the introduction of a user-designed, single multimodal form and gamification. Qualitative analysis demonstrated a shift from initial resistance (CFIR: compatibility, complexity) to normalisation (implementation climate), although technical challenges with image archiving persisted. User-centred co-design and peer engagement were key to the improvement, although persistent infrastructure challenges limited further gains and highlighted the need for informatics-enabled solutions. This study demonstrates that low-cost, context-sensitive strategies can enhance POCUS documentation effectively in high-volume, resource-constrained EDs. A multifaceted, iterative IS guided by theoretical frameworks significantly improved POCUS documentation compliance. User-centred design and participatory engagement were critical mechanisms for sustainable practice change in a resource-variable EM setting. CTRI/2024/03/063671.

Treatment of Opioid Use Disorder Across a National Emergency Department Practice Improvement Network.

Introduction: The use of ultrasound imaging as a bedside diagnostic tool has become widely accepted in emergency departments across the globe. However, the adoption of clinical ultrasound is still fragmented, with this discrepancy being most notable in rural or developing healthcare facilities. This is a feasibility evaluation of a low cost tele-mentoring model to guide non-proficient operators through two-point compression US evaluating bilateral lower extremities for deep venous thrombosis (DVT). Methods: A convenience sample consisting of six first-year medical students was enrolled in the study. Using a two-way zoom video and audio call, the guiding physician (off-site) directed the participant through the DVT exams by providing instructions on patient positioning, probe placement, image optimization, and venous compression. The exams were evaluated by two ultrasound fellowship trained third-party emergency medicine physicians to validate if the archived images were diagnostic (Yes/No); to grade (1-5 score) the image quality using the reporting guidelines established by the American College of Emergency Physicians. Results: Six participants were enrolled in the study, with all participants reporting that the instructions from the guiding physician were easy to understand, with a mean score of 9.9/10. All participants felt their ultrasound examination had high diagnostic value, and their experience with the tele-mentoring session improved their ultrasound skills, with means of 9/10 and 9.7/10, respectively. External validating physician 1 scored 50% of the exams as diagnostic with a mean image quality rating of 3.5/5. External validating physician 2 scored 83% of the exams as diagnostic with a mean image quality rating of 3.6/5. Conclusion: The use of a tele-mentoring model facility diagnostic facilities has potential applications in ad-hoc scenarios such as refugee, wilderness, or warfare medicine. Data from this study provided valuable insight into the role of a tele mentoring model for clinical ultrasound in rural or field emergency facilities.

Pediatric Readiness in the Emergency Department: Policy Statement.

Diagnostic pitfalls and forensic implications of hyperactive delirium with severe agitation: an Italian case series.

Advanced practice providers (APPs), including nurse practitioners (NPs) and physician assistants (PAs), play a vital role in emergency medicine (EM), addressing workforce shortages and enhancing patient care. Despite their growing presence, position statements from the American College of Emergency Physicians (ACEP) and the American Academy of Emergency Medicine (AAEM) challenge APP autonomy and scope of practice. This article critically examines the educational pathways, clinical competencies, and certification standards of APPs, highlighting disparities in recognition and misrepresentation of training. It explores the historical context of EM specialization, the evolution of APP roles, and the impact of restrictive policies-particularly in underserved areas. The authors propose actionable solutions, including standardized credentialing, formal recognition of postgraduate training, and policy reform to support full practice authority. Emphasizing collaboration over division, the article advocates for a team-based approach to emergency care that values the contributions of all provider types and promotes equitable integration.

Gender Representation Among Invited Physician Speakers at National Emergency Medicine Conferences.

This is a revision of the previous joint policy statement titled "Pediatric Readiness in the Emergency Department." This is a joint policy statement from the American Academy of Pediatrics, the American College of Emergency Physicians, the American College of Surgeons, and the Emergency Nurses Association. These updated recommendations are intended to serve as a resource for clinical and administrative leadership of emergency departments as they strive to improve their readiness for the emergency care of children of all ages.

Pediatric Readiness in the Emergency Department: Policy Statement.

Background: Disaster as per the American College of Emergency Physicians is “when the destructive effects of natural or man-made forces overwhelm the ability of a given area or community to meet the demand for health care”. In this article, I have discussed about the role of biomedical engineers, Gas plant technician role in a hospital, Brief explanation of Disaster and its consequences, Precautionary steps to be taken by BME and gas plant for disaster, during disaster, post disaster and challenges expected during the disaster. Methods: In this, the role of biomedical engineers or Clinical Engineers, Gas plant technician role in a hospital, Brief explanation of Disaster and its consequences, Precautionary steps to be taken by BME and gas plant for disaster, during disaster, post disaster and challenges expected during the disaster, and wrote the summary of this. Results: Biomedical Engineers role starts from procurement, maintenance, safety and till decommissioning of medical equipment and their interaction. The technicians associated to this plant involve in the management of the above gases where they help in storage, handling, distribution of medical gas cylinders. When the news regarding the situation has been informed, minimum two engineers are to be deputed to collect data of the unutilized critical care equipment which are not being connected to the patient in ICUs. Arrangements for shifting of this equipment are to be started immediately. Conclusion: Handling precautionary measures for disaster management will aid in reducing the risks and the consequences involved during disaster thereby saving lives and reducing physical losses Key Words: biomedical engineering, medical gas plant, phases, disaster management

ObjectivesThis study aimed to assess the current utilization of artificial intelligence (AI) tools among emergency physicians, their attitudes toward AI in clinical practice, and how a national physician professional organization could best support its members regarding AI.MethodsA cross-sectional survey was emailed to American College of Emergency Physicians members and made available to conference attendees at a national symposium. The survey collected demographic information, details on the use of noninstitutional and institutional AI tools, attitudes toward AI, and desired forms of support. Descriptive statistics were used to summarize the data.ResultsA total of 658 physicians responded, primarily practicing attendings (78%) and residents (9%), with 60% aged 35 to 54 years and 67% identifying as male; these respondents represented 2% of the membership of American College of Emergency Physicians. Noninstitutional AI tool use (eg, ChatGPT and independent electrocardiogram interpretation) was reported by 31% of respondents. Institutional AI was integrated into 52% of respondents’ practices, with 18% regularly using ambient AI documentation and 22% using AI-assisted clinical decision support. AI tools for point-of-care ultrasound were available to 10%, and AI-assisted radiology interpretation was used by 14%, mainly for X-rays and computed tomography. Operational AI for triage, capacity management, and staff optimization were reported by 15%, while 9% used AI-assisted coding and billing. Moreover, 75% believed AI improves clinical efficiency, 57% felt it enhanced care quality, but 12% expressed concern about job displacement, 16% are unsure whether AI tools would adequately comply with Health Insurance Portability and Accountability Act regulations, and 38% noted potential biases. About half desire educational support and guidelines.ConclusionIn this nonrepresentative emergency physician survey, respondents reported moderate rates of adoption of AI tools and generally positive attitudes toward AI’s impact on efficiency and care quality. However, respondents also reported important concerns about job displacement, Health Insurance Portability and Accountability Act regulation compliance, and potential biases. Larger studies are needed to more fully understand emergency physician views on AI.

Understanding and Addressing Bias in Artificial Intelligence Systems: A Primer for the Emergency Medicine Physician

Older adults frequently present to the Emergency Department (ED). In response, a Swiss university hospital introduced age-friendly interventions and achieved Geriatric Emergency Department Accreditation (GEDA) by the American College of Emergency Physicians (ACEP). However, the impact of previously introduced interventions and the reasons behind emergency clinicians' varying uptake or lack of continued use remain unclear. To further improve patient outcomes, conducting a contextual analysis to identify implementation barriers and facilitators is crucial, followed by the development of tailored implementation strategies supporting the sustainable uptake of all age-friendly program elements. The project's overall aim is to systematically promote the uptake and sustainable re-implementation of the existing age-friendly ED program. The first study phase outlined in this protocol ("Phase A") focuses on 2 key objectives: (1) to assess current age-friendly interventions in the ED and identify barriers and facilitators affecting their reach, adoption, implementation, and maintenance; (2) to develop tailored implementation strategies for re-implementing program elements. This project uses a modified implementation mapping in 5 Steps across 2 Phases. Phase A includes Steps 1-4: (1) conducting a contextual analysis using a mixed-methods design combining observations, interviews, patient chart reviews, E-survey and a Gemba walk; (2) identifying expected intervention and implementation outcomes, performance objectives; (3) adapting, extending, or developing tailored implementation strategies based on the Expert Recommendations for Implementing Change taxonomy; and (4) co-designing an implementation protocol to guide re-implementation. The follow-up Phase B will involve the re-implementation of the intervention elements and co-designing the evaluation protocol (Step 5) for the implementation process. Age-friendly EDs are essential for person-centered emergency care, enhancing safety and quality of care for older adults. This study will provide insights into adaptable, evidence-informed implementation strategies that support behavioral change among emergency clinicians to increase patient reach and sustainability of age-friendly interventions for complex ED settings.

Asymptomatic Acute Hypertension in Nursing Home Residents: Rarely an Emergency.

Introduction: Point-of-care ultrasound (POCUS) is increasingly recognized as a valuable diagnostic tool in emergency departments, particularly for evaluating non-traumatic acute abdominal pain. This study assessed the diagnostic accuracy of POCUS in identifying the most common causes of acute abdominal pain, i.e., appendicitis, cholecystitis, bowel obstruction, and renal colic, presenting in an emergency setting.Methodology: This prospective observational study was conducted over 12 months at Mardan Medical Complex and District Headquarters (DHQ) Teaching Hospital, Gujranwala, Pakistan. A total of 180 adult patients (≥18 years) presenting with non-traumatic acute abdominal pain were enrolled using convenience sampling. POCUS was performed by trained emergency physicians in accordance with American College of Emergency Physicians (ACEP) guidelines. Final diagnoses were confirmed through radiological, surgical, or clinical outcomes. Data were analyzed using SPSS version 26.0 (IBM Corp., Armonk, NY). Statistical measures included sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy.Results: The mean age of the patients was 39.5 ± 13.6 years (range: 18-80 years), with a slightly higher male predominance: 94 (52.2%) males and 86 (47.8%) females. The most common final diagnoses were appendicitis (44, 24.4%), renal colic (34, 18.9%), cholecystitis (30, 16.7%), and bowel obstruction (28, 15.6%). POCUS correctly identified the pathology in 150 (83.3%) cases. Condition-specific diagnostic accuracies were appendicitis at 92.2%, cholecystitis at 93.7%, bowel obstruction at 94.2%, and renal colic at 93.9%. Cases with nonspecific or unidentifiable abdominal pain were grouped under “Other” and not stratified further. Gender-based accuracy was comparable, with 79 (84.0%) correct diagnoses in males and 71 (82.6%) in females.Conclusion: POCUS demonstrated high diagnostic accuracy for four of the most common abdominal emergencies, i.e., appendicitis, cholecystitis, bowel obstruction, and renal colic, and showed consistent performance across genders. While these findings support the role of POCUS as a valuable tool in emergency settings, particularly in resource-constrained environments, they should be interpreted within the study’s scope. Broader generalization to all causes of abdominal pain requires further research with larger, more diverse patient populations and long-term follow-up.

IntroductionPatients with respiratory distress are frequently encountered in the emergency department (ED). Efforts to assess, initiate treatments, and stabilize these patients require a systematic and rapid response. Emergency physicians need a comprehensive and efficient approach for evaluating, treating, and managing patients presenting to the ED with moderate respiratory distress.MethodsThe American College of Emergency Physicians convened an expert panel of academic and community emergency physicians, critical care specialists, respiratory therapists, hospitalists, and pharmacists to develop and subsequently disseminate consensus recommendations regarding the diagnosis and treatment of patients with moderate respiratory distress presenting to the ED.ResultsA digital tool using a consensus-based framework was developed to aid emergency clinicians in diagnosing and caring for patients with moderate respiratory distress. The tool can be employed at each step in the diagnostic and treatment process.ConclusionThe evidence-based tool is a practical and freely available bedside instrument for emergency clinicians to diagnose and treat patients with moderate respiratory distress. Further studies are needed to examine the effectiveness of this approach.

Tranexamic Acid in Trauma.